Modern Pediatrics. Ukraine

Peculiarities of acoustic diagnostic methods in pediatric practice (literature review, own research)

Yu.V. Marushko — 2024-10-28

Diseases of the respiratory system are among the most common among the population of different age categories. Sound, as a physical phenomenon, is the propagation of longitudinal elastic waves in a medium, for example, in the air. Waves with frequencies below 16 Hz are called infrasound, and above 20,000 Hz are called ultrasound, and these waves cannot be perceived by the human ear. That is why the study of acoustic signals is extremely important for the diagnosis and monitoring of respiratory diseases.

The aim of this article is to investigate the features of the use of acoustic diagnostic methods in pediatric practice through the analysis of contemporary literature over the past five years, sourced from Scopus and Web of Science databases, as well as conducting original clinical research.

Results. Acoustic diagnostic methods in pediatrics have great potential due to their non-invasiveness and lack of radiation exposure. Literary sources indicate the high efficiency of these methods in detecting pathologies of the respiratory system in children, especially in the early stages of diseases. Our research with the acoustic monitoring device "Trembita-Corona" confirmed the ability to accurately determine the affected areas of the lungs with the help of highly sensitive acoustic sensors. The primary focus is paid to the comparative evaluation of the diagnostic efficacy, safety, and potential for using these methods in children of different age groups. It has been proven that acoustic methods allow the identification of pathological changes even in hard-to-reach extracostal areas. The effectiveness of the acoustic monitoring device "Trembita-Corona" developed and implemented in clinical practice is confirmed by the possibility of mathematical data processing, which significantly increases the accuracy of diagnosis, excluding the human factor. The use of acoustic methods in pediatrics opens up new opportunities for early detection and monitoring of diseases of the respiratory system.

Conclusions. The implementation of acoustic methods into clinical practice is a promising direction that deserves further research and development. The conducted experimental studies demonstrated the ability of the "Trembita-Corona" device to accurately diagnose and localize lung lesions in community-acquired pneumonia, confirming the effectiveness of the developed methods and algorithms.

No conflict of interests was declared by the authors.

Water-soluble vitamins, their significance in metabolism, growth and development of children of different ages

O.M. Mochulska — 2024-10-28

Vitamins are highly biologically active low-molecular compounds of different chemical nature, with different compositions, structures, and physicochemical properties. In contrast to proteins, fats, and carbohydrates, which are macronutrients, vitamins belong to micronutrients, which have high biological activity, although they do not function as an energy source or plastic material.

Aim - to raise awareness of the biological and clinical effects of water-soluble vitamins, their importance in metabolic processes, growth and development of children.

Vitamins are classified according to their physical and chemical characteristics as water-soluble and fat-soluble. Water-soluble vitamins include C, H, P, B₁₂, B₉, B₆, B₅, B₃, B₂, B₁. Water-soluble vitamins perform the function of biological catalysts of various metabolic processes, growth and development of children, regulate most of the vital functions of the child's body, necessary for the balanced work of all organs and systems. Water-soluble vitamins do not accumulate in the body, so their concentration in tissues depends on consumption with diet. Water-soluble vitamins are extremely necessary for the growth and development, health of children of all ages. Water-soluble vitamins are extremely necessary for maintaining healthy skin and mucous membranes, ensuring adequate hematopoiesis, and the normal functioning of the cardiovascular, nervous, endocrine, and digestive systems.

Conclusions. Water-soluble vitamins are essential exogenous alimentary factors that should be steadily supplied to the child's body with food in doses in accordance with physiological needs. All vital processes in the child's body take place with the direct participation of water-soluble vitamins. Water-soluble vitamins regulate the function of various tissues, organs and systems, activating a large number of biological ones, and contribute to the body's resistance to external factors. Screening for disorders of the metabolism of water-soluble vitamins and their correction in children can improve health and increase the quality of life.

Physical activity as a component of a healthy lifestyle of Ukrainian adolescents aged 11-14

S.V. Hryshchenko — 2024-10-28

In the modern period in Ukraine, there is a trend of deterioration in the health of adolescent children aged 11-14 years. In this age period, the basic values of forming a healthy lifestyle are laid. It is necessary to form basic social attitudes about a healthy lifestyle among teenagers. The development of motor skills is closely related to health and actively affects the life of children. A healthy lifestyle is based on the readiness and motivation of teenagers for physical self-improvement. Health conservation is an effective form of both preserving and strengthening the health of Ukrainian teenagers aged 11-14 in the conditions of martial law in Ukraine.

The aim of the research is to carry out a systematic analysis of scientific sources in which various aspects of the motor activity of Ukrainian adolescents aged 11-14 years are investigated as a component of a healthy lifestyle.

Motor activity involves a system of active motor actions of teenagers, aimed at creating and forming vital motor skills and skills that determine the preservation and strengthening of health. Solving the problem of motor activity as a component of a healthy lifestyle of Ukrainian teenagers aged 11-14 years by means of physical education and development of motor actions is possible by searching for the latest effective methods.

In order to achieve a high level of motor activity of teenage children, pediatricians, physical education teachers, social specialists, parents of teenagers need to have knowledge in the field of medicine, biology, psychology, pedagogy and methods of physical education, organization and conducting of mass health and sports events. And for teenagers, it is necessary to have practical skills and abilities, as well as the methodology and technique of physical exercises.

The authors declare no conflict of interest.

Peculiarities of humoral immunity parameters in newborns with markers of undifferentiated connective tissue dysplasia

O.Yu. Chumak — 2024-10-28

Connective tissue dysplasia can affect the immune response in children. The study of humoral immunity indicators in newborns with locomotor and biochemical markers of undifferentiated connective tissue dysplasia (UCTD) is very relevant.

Aim - study the correlations between anthropometric, laboratory markers of UCTD and indicators of the B-cell link of immunity in newborns.

Materials and methods. We examined 122 newborns: 79 full-term and 43 premature infants. In them, the perinatal history data were analyzed, anthropometric and biochemical (matrix metalloproteinase-1 (MMP-1), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1)) markers of UCTD were studied, and the ratio of MMP-1/TIMP-1 was calculated. The absolute number of B-lymphocytes and the levels of immunoglobulins of classes A (IgA), M (IgM), G (IgG) in the blood were also investigated. The main group (n=82) consisted of newborns with elevated values of ≥2 anthropometric markers of UCTD, the control group (n=40) included children without deviation from the norm of any anthropometric index.

Results. Children with signs of UCTD are more likely to be born from ≥2 births, with a body weight of 2499-2000 g and ≤1999 g, and have lower levels of serum IgA, IgM than children of the control group. Such perinatal factors as operative delivery and parity of more than two births can be considered prognostically unfavorable for a lower absolute number of B-lymphocytes, lower levels of IgA and IgM in the blood of newborns. Serum content of MMP-1≥4.51 ng/ml, values of MMP-1/TIMP-1≥0.31 are associated with a higher absolute number of B-lymphocytes and lower level of IgA, also the concentration of TIMP-1≥16.08 ng/ml is associated with higher levels of IgA, IgM, IgG. The content of serum immunoglobulins correlates with the gestational age.

Conclusions. Therefore, newborns with anthropometric markers of UCTD and an imbalance of biochemical markers (MMP-1, TIMP-1, index MMP-1/TIMP-1) have lower levels of serum IgA and IgM. The concentration of MMP-1≥4.51 ng/ml, MMP-1/TIMP-1≥0.31, TIMP-1≤16.07 ng/ml are prognostically unfavorable factors regarding changes in the B-cell immunity in newborns. The lowest concentrations of immunoglobulins of all classes were recorded in children with a gestational age of 31-28 weeks.

The study was carried out according to the principles of the Declaration of Helsinki. The study protocol was accepted by the Local Ethical Committee of these institutions. The informed consent of the children's parents was obtained for the research.

The authors declare no conflict of interest.

The role of sensitization to aeroallergens and its determination in children with asthma in Ukraine

O.V. Mozyrska — 2024-10-28

Asthma is a very common respiratory disease in the world. In particular, asthma has a great impact on the health of children. In this study, the distribution of sensitization among children with asthma has been analyzed.

The aim of this study was to investigate the distribution of sensitization among children with asthma in the Ukrainian population.

Materials and methods. The study involved patients (n=98) with asthma aged from 12 to 18 years (median 6 (3;10)). During the examination, children underwent skin prick testing for common aeroallergens. A positive skin prick test was defined as a blister ≥3 mm in diameter after 15 minutes.

Results. Among 98 patients, skin testing with aeroallergens showed a positive result in 76 (77.6%) people: 18 (18.4%) had positive skin testing for at least one allergen, and 58 (59.2%) had polysensitization. Among those sensitized children, 54 (55.1%) were sensitive to pollen allergens, 29 (29.6%) patients were sensitive to cats, 32 (32.6%) to dogs, 30 (30.6%) to Dermatophagoides pteronyssinus, 27 (27.6%) to Dermatophagoides farinae, and 10 (10.2%) to Alternaria.

Conclusion. The most important inhalant allergens for patients with bronchial asthma are pollens (trees, grasses, and weeds), house dust mites, molds, and animal dander. Identifying causative allergens allows for monitoring allergy triggers and determining which asthma patients will be candidates for allergen-specific immunotherapy (ASIT). Today, most children with asthma do not receive ASIT because of the lack of awareness at the primary care level, a lack of testing for aeroallergen sensitization, and financial inaccessibility of examination and treatment in Ukraine.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethical Committee of these institutions. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

Influence of immunosuppressive therapy on the state of immune protection in children

M.I. Kravtsiv — 2024-10-28

For the treatment of rheumatological diseases, autoimmune lymphoproliferative syndrome and nephrotic syndrome in children, glucocorticosteroid therapy with/without cytostatics is used. Immunosuppression is a serious side effect of these medications.

Aim - to investigate immunological parameters in children receiving immunosuppressive therapy in order to determine vaccination tactics.

Materials and methods. 50 healthy children (comparison group) and 34 children who received immunosuppressive therapy for rheumatological pathology, autoimmune lymphoproliferative syndrome or nephrotic syndrome (study group) participated in the study. Patients who received high-dose immunosuppressive therapy (n=16) made up the subgroup I, low-dose immunosuppressive therapy (n=18) - the subgroup II. Determination of subpopulations of blood lymphocytes was carried out by the method of flow cytometry, serum immunoglobulins - by the method of radial immunodiffusion. Statistical analysis was performed using the SPSS 23.0 software package.

Results. In children who received immunosuppressive therapy, a significant increase in the number of T-lymphocytes (CD3+), a decrease in B-lymphocytes (CD19+) and NK cells (CD3-CD16/56+) was established, while the average levels of serum IgA, IgM, IgG did not differ from the indicators of healthy children, which demonstrates the preservation of humoral immunity. However, in children who received high-dose immunosuppressive therapy, a dose-dependent decrease in the level of serum IgA, IgM, and IgG was found, respectively, by 1.7, 1.3 times, and by 18.9%.

Conclusions. It is advisable to vaccinate children before starting immunosuppressive therapy for rheumatological pathology or nephrotic syndrome.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

The role of epigenetic factors in the pathogenesis of dysmetabolic nephropathy with calcium oxalate crystalluria in children

N.R. Aib — 2024-10-28

The prevalence of dysmetabolic nephropathies in children is increasing from year to year, representing a significant problem in the overall structure of kidney diseases in pediatric age. Despite numerous studies dedicated to the issue of dysmetabolic nephropathies in children, the role of epigenetic factors in the pathogenesis of dysmetabolic nephropathy with calcium oxalate crystalluria remains insufficiently explored.

Aim - to identify the leading epigenetic factors in the pathogenesis of dysmetabolic nephropathy with calcium oxalate crystalluria in children.

Materials and methods. The data from the medical histories and outpatient records of 173 children were studied. Each child was additionally examined by narrow specialists of different profiles. Three groups were formed from the examined children: Group I - children with a complicated course of dysmetabolic nephropathy and a history of inflammatory processes in the urinary system (52 children), Group II - children with dysmetabolic nephropathy with persistent crystalluria (56 children) and the Control group, which included 65 healthy children.

Results. The most significant prenatal epigenetic factors are the threat of early miscarriage, gestosis of the first and second halves of pregnancy, maternal anemia during pregnancy, parental alcohol and tobacco use, mother's work on computer during pregnancy, presence of maternal chronic diseases, parental exposure to industrial dust and noise, and heavy physical work of mother leading to fetal hypoxia.

Conclusion. The most significant postnatal epigenetic factors influencing children's susceptibility to a more severe course of dysmetabolic nephropathy included low birth weight, early artificial feeding, frequent acute respiratory infections, atopic diathesis, and physiological jaundice in the first year of life, as well as the presence of concomitant diseases such as chronic tonsillitis, dental caries, frequent acute respiratory infections, chronic gastritis, atopy, and chronic cholecystitis later in life.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of these institutions. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

The level of awareness of the medical community with Marshall syndrome (PFAPA)

E.I. Burbela — 2024-10-28

Syndrome of periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA - periodic fever, aphthous stomatitis, pharyngitis, adenitis), known as Marshall syndrome (SM.). In Ukraine, with its child population of about 7.6 million. it should prognostically be established in at least several thousand cases, but reports of such children are only sporadic, attesting to diagnostic problems.

Aim - to evaluate the level of knowledge of doctors of certain specialties regarding the diagnosis of SM and finding a way to improve the efficiency of its management.

Materials and methods. An anonymous survey of 157 residents and interns of the Ternopil region of Ukraine was conducted regarding the diagnosis of SM and its management using a written questionnaire followed by statistical processing. Exclusion criteria were the absence of answers or the number of answers to at least one of the questions asked was greater than the suggested number. Therefore, 139 questionnaires were taken into analysis, among which 56 (40.29%) were provided by specialist doctors and 83 (59.71%) by intern doctors.

Results. The analysis of the answers showed difficulties not only with establishing the correct diagnosis, but also with its diagnosis and treatment tactics both among specialists with experience and among interns. About quarter of the residents (13/56 (23.21%)) and only 8/83 (9.64%) of the interns decided on the treatment tactics of the patient in accordance with the described clinical picture and the specified diagnosis, which testified to a lack of understanding of the pathogenetic bases of SM. Despite the fact that the clinical symptoms of MS most interns (67/83; 80.72%) are known and they recognized it based on the description provided by the questionnaire. The biggest difficulties arose in both groups when solving the issue of planning preventive measures in the inter-attack period.

Conclusions. Thus, the analysis of the conducted survey revealed a lack of knowledge about MS, its diagnosis, treatment and rehabilitation. Autoinflammatory diseases need their place in modern programs of university training and especially postgraduate education in the continuous professional development system in order to direct the vector of medical opinion clearly in the direction of the correct clinical diagnosis.

No conflict of interests was declared by the authors.

Regional characteristics of the incidence of congenital anomalies, deformities, and chromosomal disorders in newborns in Ukraine

L.O. Turova — 2024-10-28

Aim - to determine the regional characteristics of the incidence of the nosological group “Congenital Anomalies, Deformities, and Chromosomal Disorders” (Q00-Q99), considering the availability of genetic doctors and the pregnancy examination rate in Ukraine.

Materials and methods. Statistical data from were analyzed for the period 2012-2021. Incidence rates per 1,000 newborns for the nosological group “Congenital Anomalies, Deformities, and Chromosomal Disorders” (Q00-Q99) were calculated, along with the availability of genetic doctors per 1 million population and the examination rate per 100 pregnant women. Linear regression models were used for mathematical modeling, and model quality was evaluated using the coefficient of determination (R²). Correlation analysis was conducted among the indicators.

Results. Ukraine experienced a significant increase in the incidence of the group “Congenital Anomalies, Deformities, and Chromosomal Disorders” (Q00-Q99) from 2012 to 2021 (from 22.64‰ to 28.49‰), with a projected increase to 33.91‰ by 2026. Regional incidence variation ranged from 47.4‰ in the Volyn to 11.75‰ in the Kirovohrad Oblast. There is a decrease in the number of examined pregnant women per 100 pregnant women from 2012 to 2022 by -8.62%, from 39.84 per 100 pregnant women in 2012 to 36.41% in 2021.

Conclusions. The formed rating distribution of regions by morbidity indicators, provision of geneticists, the indicator of pregnant women examined in the medical genetic service and the growth rate of the indicated indicators from 2012 to 2021 indicates the best result in Poltava, Kirovohrad, Cherkasy Oblast and the existence of significant problems in the organization of medical genetic counseling in Zakarpattia, Lviv and Volyn Oblast.

No conflict of interests was declared by the authors.

Profile of sensitization to fish and seafood allergens in children with allergic conditions in different regions of Ukraine

Yu.V. Marushko — 2024-10-28

The significant increase in allergic reactions to fish and seafood among children in recent years is unabated worldwide. About 40% of children with a food allergy (HA) to seafood are at risk of systemic reactions.

Aim - to determine the prevalence and profile of sensitization to fish and seafood in children in Ukraine; to analyze its age and regional features.

Materials and methods. 3,513 children aged 1 to 18 years with various allergic diseases were examined using molecular component immunoenzymatic analysis of venous blood with the ALEX2 test system (Macro Array Diagnostics GmbH, Austria). The prevalence and structure of sensitization to fish and seafood allergens in children was established, depending on age and region of residence.

Results. Among the examined, sensitization to fish and seafood was detected in 529 (15.1%) children, of which 15 (2.8%) were 1-2 years old, 123 (23.3%) were 3-5 years old, in 173 (32.7%) - aged 6-8 years, in 111 (20.9%) - aged 9-11 years old; in 67 (12.7%) - aged 12-14 years; 40 (7.6%) are 15-17 years old. More often, sensitization to fish and seafood was observed in children from the southern (55 (21.2%) children) and central regions of Ukraine (102 (19.8%) children). Sensitization to fish prevailed - (in 433 (81.9%) children), to seafood - in 96 (18.1%), simultaneously to fish and seafood - in 58 (11%) children. Most children were sensitized to β-parvalbumin: carp - in 291 (55.0%) children, cod - in 206 (38.9%), salmon - in 239 (45.2%), mackerel - in 45 (8, 5%). Sensitization to lobsters was detected in 79 (14.9%) children, crabs in 76 (14.4%), oysters in 73 (13.8%), shrimps in 65 (12.3%) children.

Conclusions. The problem of allergy to fish and seafood in children is urgent. Prevalence of sensitization to fish, mainly to β-parvalbumins of salmon, mackerel and tuna, was revealed. Among seafood, sensitization to lobsters, crabs, oysters and tiger prawns prevailed (in 14.9-12.3% of children). Allergy to fish and seafood was more common in children from the central and southern regions of the country (19.8-21.2% of children).

The studies were carried out in accordance with the principles of the Declaration of Helsinki. The protocol was approved by the Local Ethics Committee of the institution indicated in the work. Information consent from parents and children is obtained for conducting research.

No conflict of interests was declared by the authors.

The impact of various options of the prenatal informational preparation on the success of breastfeeding children

T.O. Kirsanova — 2024-10-28

Breastfeeding definitely has many benefits for the baby, the mother, and the family in general.

Aim - to study the impact of various methods of prenatal preparation on breastfeeding.

Materials and methods. The survey was conducted of 578 families that gave birth to children in the last 10 years. Families were divided into 8 groups depending on how they prepared for the birth of a child.

Results. Most had children in their first two years. During pregnancy, they more often planned to breastfeed. A third planned to breastfeed until 1-2 years. The chance that they would plan to breastfeed for 6 months was 5.4 times higher in the first group compared to the third, 4.3 times higher in the second versus the third. Most children received supplementation before breastfeeding at least once, most often formula. 80% first gave supplementation in the maternity hospital compared to the total number of families that supplemented with formula. The chance of giving formula in the maternity hospital was 2.5 times higher than not giving at all in the first and second groups. ²/₃ had problems with breastfeeding, the smallest chance in the fifth group. 70% sought help when problems first arose, most often in the fourth and fifth groups. Most of all, they turned to lactation consultants or doctors. Half believed that they could be helped. The chance of being able to help in the fourth group is 33 times greater than in the first, 17 times greater than in the second, and 68 times greater than in the eighth.

Conclusions. Most parents, regardless of the preparation level for the childbirth or without preparation at all, have plans to breastfeed their children, but the more information the family receives before the birth, the less likely: the child will receive supplemental formula; that there will be a problem with breastfeeding; the family is more likely to: seek help; that they will search help from a qualified specialist; that breastfeeding will last longer. The more the family is aware of issues related to BF during pregnancy, the more successful BF will be after the baby is born.

No conflict of interests was declared by the authors.

Clinical and genetic characteristics of children with type 1 Gaucher disease in Ukraine

O.V. Zozulya — 2024-10-28

Gaucher disease type 1 (GD1) is one of the most common lysosomal storage disorders. This disease is caused by a deficiency of the acid β-glucosidase enzyme, which is encoded by the GBA gene. Deficiency of this enzyme leads to the accumulation, in particular, of glucosylsphingosine (Lyso-GL-1) in cells of the monocyte line of macrophages.

Aim - evaluate and analyze statistical data; establish the features of the clinical course and therapeutic management of GD1 in children.

Materials and methods. We examined 27 children with GD1 who live in Ukraine. Clinical and laboratory data of the course of the disease, the presence of mutational status and the observation stage were taken into account: at the time of diagnosis and after 5 years of treatment.

Results. Progressive anemia, thrombocytopenia and hepatosplenomegaly were found in the general group of patients. Skeletal disease led to pain in the bones and presence. bone crises. Gaucher disease type 1 shows significant genetic variability due to different mutations in the GBA gene, including N370S, L444P and the complex N370S/84G mutation. The type of mutations affects the level of Lyso-Gl-1, which determines the severity of clinical manifestations, in particular, found among our patients with the N370S/84GG mutation. Patients with GD1 and various mutations have a variable clinical course. A milder course of the disease was observed in patients with the N370S and L444P mutation, while the complex allelic combinations, N370S/84GG, lead to a more severe course of the disease. Enzyme replacement therapy (ERT) is the mainstay of treatment and has been shown to be highly effective in most patients with GD1, especially those with mild mutations, using imiglucerase.

Conclusions. The high genetic and clinical heterogeneity of GD1 emphasizes the importance of a personalized approach to treatment that takes into account the individual genetic characteristics of each patient. Integrating genetic analysis with clinical assessment is key to optimizing treatment and improving patient outcomes. These findings highlight the importance of understanding the genetic basis of GD1 to improve patient diagnosis, prognosis, and treatment.

The study was conducted according to the principles of the Helsinki Declaration. Informed consent was obtained from the patients for the study.

The author declares no conflict of interest.

Comparative assessment of quality of life and functional status of children with cerebral palsy according to their early treatment

O.V. Kyryk — 2024-10-28

Cerebral palsy (CP) is a leading cause of childhood disability, significantly impacting the quality of life of children and their families. Early intervention (EI) programs aim to mitigate the negative effects of CP, improving social adaptation and functional abilities.

Aim - to conduct a comparative analysis of the quality of life of children with spastic CP depending on whether they received EI services before the age of four.

Materials and methods. The study involved 105 children aged 4-14 years, divided into two groups: Group A (43 children who received EI) and Group B (62 children who did not). Assessment was conducted using standardized international classifications, and quality-of-life questionnaire.

Results. Children in the Group A demonstrated significantly higher scores in "Participation" (6.37 vs. 5.19), "Communication" (7.40 vs. 6.82), "Access to Services" (5.14 vs. 4.69), and "Social Adaptation" (101.7 vs. 87.19). The Group A also reported lower pain levels on the, with 46.5% of children experiencing mild pain (level 2) compared to 21% in the Group B. The greatest positive impact of EI was in social integration, physical well-being and participation in daily activities.

Conclusions. Early intervention improves the quality of life of children with CP, enhancing their social adaptation, reducing pain, and increasing independence.

No conflict of interests was declared by the authors.

Comprehensive analysis of genotype-phenotype correlation in the diagnosis of undifferentiated recurrent fever syndrome in children

O.R. Boyarchuk — 2024-10-28

Syndrome of undifferentiated recurrent fever (SURF) is a heterogeneous group of autoinflammatory diseases characterized by episodes of systemic inflammation without a confirmed molecular diagnosis and not meeting the criteria for Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenopathy (PFAPA) syndrome. Overall, a genetic diagnosis cannot be established in 30-60% of children with recurrent fever syndrome.

Aim - to present a clinical case of undifferentiated recurrent fever syndrome in a child triggered by COVID-19 and to raise awareness of this syndrome within the medical community.

The clinical case involves a 6-year-old boy experiencing recurrent fever accompanied by arthralgia, fatigue, and significant inflammatory changes in the blood. The first fever episode followed a SARS-CoV-2 infection with pneumonia, and subsequent episodes occurred 2-3 weeks after respiratory infections. Genetic testing revealed a variant of uncertain significance in a heterozygous state in a gene associated with MEFV-like diseases. The absence of sufficient clinical criteria ruled out the diagnosis of Familial Mediterranean fever at this stage, allowing for a diagnosis of undifferentiated recurrent fever syndrome (SURF).

Conclusions. Thus, identifying the cause of recurrent fever in children is not always easy or possible. The analysis of genotype-phenotype correlation has an important role in diagnosis in the case of variants of uncertain significance. Viruses, especially SARS-CoV-2, can triggered hyperinflammation. Raising awareness of this syndrome among the medical community will contribute to timely treatment and the prevention of complications.

The study was conducted according to the principles of the Helsinki Declaration. Informed consent was obtained from the patient for the study.

The author declares no conflict of interest.

Hemorrhagic vasculitis in an adolescent induced by the COVID-19 virus

S.O. Nykytyuk — 2024-10-28

Hemorrhagic vasculitis (Henoch-Schönlein purpura) Vasculitis is a common disease that is often preceded by a bacterial or viral infection of the upper respiratory tract.

Aim - to investigate the specifics of the course and treatment of hemorrhagic vasculitis in a child after suffering from COVID-19 on the example of a clinical case.

Clinical case. A case of acute hemorrhagic vasculitis in a 14-year-old boy is presented. A boy was admitted to Ternopil Regional Children's Clinical Hospital with complaints of a rise in body temperature to high numbers, the appearance of rashes on the lower limbs, buttocks, pain and swelling in the knee joints. From the anamnesis of life, it is known that 2 weeks before the appearance of this hemorrhagic syndrome, he suffered from COVID-19. The disease began acutely with an increase in temperature of 40.1°C. Specific disorders associated with vasculitis/capillaritis are considered in detail: clinical syndromes are identified during objective examination: intoxication, hemorrhagic, articular. Examinations were carried out: general blood test, general urine test, biochemical tests. Maintenance therapy with sufficient hydration, restoration and maintenance of electrolyte balance. In order to control pain, simple analgesics (paracetamol 15 mg/kg every 6 hours orally) were prescribed. A differential diagnosis was made with meningococcal infection, idiopathic arthritis, and thrombocytopenia. The algorithm for the diagnosis of hemorrhagic vasculitis is presented. The need to be vigilant about the development of hemorrhagic vasculitis in children who have suffered from COVID-19 is justified.

The research was carried out in accordance with the Declaration of Helsinki. Informed consent of the child's parents was obtained for the research.

No conflict of interests was declared by the authors.

Giant encephalocele in a child (clinical case)

L.A. Volianska — 2024-10-28

One of the embryonic neural tube congenital defect variants, which occurs in the early stages of pregnancy as a result of its improper closure and is the reason for the disability or death of the newborn, is the protrusion (herniation) of the intracranial contents due to the defect of the dura mater and the skull, known as encephalocele.

Aim - to increase the awareness of doctors about meningoencephalocele in newborns, the causes and the emergence of opportunities for pre-gravid training as a prevention of this pathology based on the analysis of a clinical case observed from birth and during the next few months of life.

A clinical case of a congenital malformation of the central nervous system is described: meningoencephalocele of giant sizes in combination with multiple stigmata of dysembryogenesis. Research in recent years suggests that neural tube defects are the result of an interaction between environmental and genetic factors that affect the determination of genotypes and the susceptibility of embryos to teratogens. 20% are caused by genetic factors, the rest are non-genetic. Since one of the main pathogenetic factors of this pathology is the balanced and folic acid-sublimated nutrition of the pregnant woman, which is primarily determined by the financial capacity of the family and the state, our case is exactly this: a family with a low financial status, the woman has frequent pregnancies with minimal intervals between them, lack of pre-gravid training.

The study was carried out in compliance with the principles of the Declaration of Helsinki. Written consent of the patient's mother was obtained for the study and publication of its results.

The authors declare no conflict of interest.